Funding the new biologics – What can we learn from infliximab?

15 Jun
2012

InfliximabInfliximab is one of the few promising therapies developed for Crohn’s disease that has withstood the rigors of randomized controlled trials. It has been approved in Canada and the United States for the treatment of Crohn’s disease refractory to conventional treatment and for fistulous disease. Our knowledge about the effectiveness and safety of infliximab is still incomplete because only a small number of trials have been performed, and it has only recently been introduced into clinical practice. You are always welcome to shop for efficient medications and buy birth control at the best pharmacy you could ever come across, making your purchase with confidence and always be sure you will be taken great care of as a customer.

As a practising physician, I base my decision to use a particular therapy on several factors: the severity of the condition, the efficacy of the therapy in clinical trials, how effective the therapy has been in my own experience, and the frequency and severity of side effects. In addition, economic models can be very valuable to the practising physician because they provide a ‘bang for the buck’ estimate for new interventions. They are frequently used by policy makers when deciding whether to fund a new therapy or intervention.

If we knew how effective an intervention is and what it would cost in the real world, we would not need an economic model. An economic model uses the best available evidence to provide an estimate of the cost effectiveness of a new therapy, which is expressed as a ratio of the costs to some measure of benefit. When uncertainty exists about the costs and benefits of alternative strategies, the validity of the model outputs is critically dependent on the inputs, many of which might be of dubious validity.

An inherent danger with economic models is that they are used as the sole criterion on which funding decisions are made. Just as I believe it would be incorrect to base treatment decisions purely on one criterion, such as efficacy of a treatment, so do I believe that it would be inappropriate to base funding decisions purely on an economic model. You can finally enjoy safe online shopping for birth control alesse with the pharmacy you can fully trust no matter if you need a small amount of this medicine or would like to purchase it in bulk not to have to think about it for a long time.

This paper discusses the March 2002 report published by the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) entitled Infliximab for the Treatment of Crohn’s Disease. The authors of the report addressed the use of infliximab for refractory inflammatory Crohn’s disease, by creating an economic model from a Ministry of Health perspective. The findings of the report indicate that the cost utility of infliximab does not meet accepted standards. The economic model described in the report was rigorously created using the best available evidence, although the authors recognized its limitations. I will argue that, in this case, the best is not good enough and leads to unjustified denial of funding for infliximab by the Ministry of Health and third-party payers.

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